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Drug dosage identifier

Cefotaxime Sodium

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Dose and administration

Meningitis and/or severe sepsis

Dose: 50mg/kg

Postnatal Age Frequency
< 7 days q12h
7 - 21 day  ≤1200g  q 12h
 >1200g  q 8h
≥21 days  ≤2000g  q 8h
 >2000g  q 6h
Full term neonates >28 days Refer to Starship Clinical Guidelines: Meningitis

Indications

  • Neonatal meningitis.
  • Empirical therapy in infants with suspected sepsis who have previously received multiple courses of antibiotics.

Contraindications

History of hypersensitivity to cephalosporins or major allergic response to a penicillin.

Precautions

Renal impairment: cefotaxime has a high renal clearance, therefore reduce dose in moderate to severe renal impairment. This is particularly important for lower birth weight infants, as the pharmacokinetics of cefotaxime are influenced by birth weight.1,2

Drug interactions

Phenobarbitone: increased risk of skin rashes
Gentamicin, amikacin: increased risk of nephrotoxicity

Clinical pharmacology

Broad spectrum third generation cephalosporin antibiotic. Refer to Reference Viewer for more information.

Possible adverse effects

  • Vomiting, diarrhoea; pseudomembranous colitis, rarely
  • Rash, pruritis, urticaria.
  • Transient disturbance of hepatic enzymes.
  • Thrombocytopenia, eosinophilia, leucopenia.
  • False positive Coombs test.
  • Superinfection with non-susceptible organisms including fungi.
  • Encephalopathy, especially with high doses in renal insufficiency.

Special considerations

Monitor renal and hepatic function.

Management of Cefotaxime administration

Description

  • Available as vials of 500 mg and 1 g.
  • White to pale yellow powder for reconstitution. Reconstituted solution is pale yellow.
  • Osmolality: 360 mOsmol/kg (at 100mg/ml in WFI); pH 4.5-6.5.

Prescription

  • Stat doses are charted on stat page of prescription chart in mg/dose.
  • Maintenance doses are charted on the prescription chart in mg/dose.

Administration

Bolus

  • Dilute to 100mg/ml with water for injection7.

      Cefotaxime (DBL) 500mg Cefotaxime (DBL) 1gram
    Powder space
    0.2ml 0.4ml
    Water to be added 4.8ml 9.6ml
      500mg in 5.0ml 1 gram in 10.0ml
      100mg in 1.0ml 100mg in 1.0ml
  • Shake vigorously. Filter during administration through a 0.2 micron Pall filter.
  • Administer over 3 to 5 minutes3.
  • Compatible with sodium chloride 0.9%, glucose 5% and glucose 10%
  • Do NOT mix with other drugs, IV solutions, strongly alkaline solutions, blood or blood products.
  • Flush line with sodium chloride 0.9% before and after infusion of cefotaxime.
  • Separate administration from aminoglycoside antibiotics by one hour eg. gentamicin, amikacin.3

Nursing considerations

  • Observe site closely for extravasation during administration.
  • Observe for signs of adverse effects, especially those suggesting a superinfection.
  • Observe for signs of renal, hepatic or haematological dysfunction during prolonged therapy.

Storage

At room temperature < 25° C until reconstitution. Protect from light.

References

  1. Cefotaxime data sheet. Auckland: AFT Pharmaceuticals Ltd, 2012.
  2. BNF for children 2011-2012. London: BMJ Group, 2011.
  3. Paediatric Injectable Guidelines (4th ed.). Melbourne: The Royal Children's Hospital, 2011.
  4. Pediatric Injectable Drugs (9th ed.), The Teddy Bear Book. Bethesda: American Society of Health-System Pharmacists, 2011.
  5. Neonatal Formulary (5th ed. ) BMJ Books
  6. Baxter K, (ed). Stockley's Drug Interactions (9th ed.). London: Pharmaceutical Press,2010.
  7. DBL Cefotaxime sodium data sheet. Wellington: Hospira NZ Limited, 2012.

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Document Control

  • Date last published: 31 January 2013
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology, Paediatric Infectious Diseases
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years